Approach to persistent ascites after liver transplantation  

作　　者：Ana Ostojic Igor Petrovic Hrvoje Silovski Iva Kosuta Maja Sremac Anna Mrzljak 

机构地区：[1]Department of Gastroenterology and Hepatology,University Hospital Center Zagreb,Zagreb 10000,Croatia [2]Department of Hepatobiliary Surgery and Transplantation,University Hospital Center Zagreb,Zagreb 10000,Croatia [3]Department of Intensive Care Medicine,University Hospital Center Zagreb,Zagreb 10000,Croatia

出　　处：《World Journal of Hepatology》2022年第9期1739-1746,共8页世界肝病学杂志（英文版）（电子版）

基　　金：Supported by the Croatian Science Foundation,Emerging and Neglected Hepatotropic Viruses after Solid Organ and Hematopoietic Stem Cell Transplantation(to Mrzljak A),No.IP-2020-02-7407.

摘　　要：Persistent ascites(PA)after liver transplantation(LT),commonly defined as ascites lasting more than 4 wk after LT,can be expected in up to 7%of patients.Despite being relatively rare,it is associated with worse clinical outcomes,including higher 1-year mortality.The cause of PA can be divided into vascular,hepatic,or extrahepatic.Vascular causes of PA include hepatic outflow and inflow obstructions,which are usually successfully treated.Regarding modifiable hepatic causes,recurrent hepatitis C and acute cellular rejection are the leading ones.Considering predictors for PA,the presence of ascites,refractory ascites,hepatorenal syndrome type 1,spontaneous bacterial peritonitis,hepatic encephalopathy,and prolonged ischemic time significantly influence the development of PA after LT.The initial approach to patients with PA should be to diagnose the treatable cause of PA.The stepwise approach in evaluating PA includes diagnostic paracentesis,ultrasound with Doppler,and an echocardiogram when a cardiac cause is suspected.Finally,a percutaneous or transjugular liver biopsy should be performed in cases where the diagnosis is unclear.PA of unknown cause should be treated with diuretics and paracentesis,while transjugular intrahepatic portosystemic shunt and splenic artery embolization are treatment methods in patients with refractory ascites after LT.

关 键 词：Liver transplantation Liver transplantation complications Ascites Hepatic graft inflow obstructions Hepatic graft outflow obstructions Acute cellular rejection 

分 类 号：R657.3[医药卫生—外科学]